The notions of complementary and alternative therapy and medicine (CAT or CAM) capture a huge range of products and practices. Those terms potentially cover familiar ‘non-invasive’ therapies like massage and aromatherapy, but also more invasive things like acupuncture through to high dose intravenous vitamins. In between is a huge range of over the counter ‘natural health products’ and specially recommended and prepared infusions and other treatments from an herbalist. One significant distinction is between those therapies or medicines used to complement more conventional healthcare, and the more uncomfortable situation – using alternatives to replace it altogether. It is difficult for healthcare providers to feel their knowledge and skills may not be wanted – whether conventional or CAT/CAM practitioners. And, increasingly, CAT/CAM practitioners are shifting from ‘the fringe’ of generally used and accepted healthcare toward the mainstream. Chiropractic and Naturopathy have been added to the list in many provinces in recent years. #Traditional Chinese Medicine is on the road to being a regulated profession in some provinces, too. Some CAT/CAM products have entered the realm of the mainstream. Melatonin, unapproved for sale in Canada until relatively recently, is now readily available, often used to help restore better sleeping. New laws are allowing for the regulation of more products and practitioners all the time.
The question is often asked, then, by patients and families – why does it sometimes seem difficult for a ‘conventional’ healthcare team to embrace CAM?
Most teams are keen to integrate many of these therapies into a patient’s treatment plan. And many are included with little hesitation. But some carry potential risks and unknown effects that are ‘cause for pause’. Potential interactions between medications provided by a patient and those prescribed by hospital professionals are one very big concern. The safety of these products is also a factor – the regulations around their production are not always as stringent as for conventional medications. And then there are other considerations many of us may not have ever thought about.
In certain situations, a hospital and its staff might even be at risk of breaking the law and risking their professional licenses if they were to agree to the requested treatment. Even when you might be following the recommendation of another licensed professional from outside the hospital, and buying the product from them, specific laws that apply to public hospitals. Certain products may not be stored in a hospital. Practitioners working in hospitals are typically staff members or other professionals who have been ‘credentialed’ and have ‘privileges’. The hospital must assure itself (and thus, the public) that all those providing services are appropriately qualified and licensed. Other unregulated practitioners can in some cases be ‘approved’ to provide services in the hospital, but it must be done with accountability. This includes documenting in the health record what is being done and by whom. These processes can be confusing and frustrating, often seeming like burdensome barriers, threats to getting what we feel is right. Communication is not always the easiest thing to make happen in these moments.
But in most such moments, communication is the most important thing. The team is more likely able to work with your CAT/CAM preferences if you talk freely and early about them. Patients, and families, are more likely to talk freely about them if the team appears open to the idea.
When the stakes are so high, as is often the case in matters of health, life and death, it is easy to become entrenched and to see a great divide between ‘us’ and ‘the other’. And because health and caring is so rooted in our beliefs, fears and even our own self-identity, that sense of ‘otherness’ can lead to deep moral distress, and more often in the pressure cooker that is a health crisis.
Here I’d always invoke the phrase used by philosophy professor Anthony Weston – ‘don’t polarize – connect’. This is potentially a chance to get to know more about the health beliefs people hold and to be frank about the disease process that is expected to unfold.
Sometimes a third party might be of help in trying to make this connection happen. If you have access to a healthcare ethicist, approach them for support in fostering understanding. Other people that might also be available and helpful are patient relations staff and spiritual care providers (especially where the health beliefs have a significant spiritual dimension).
The real trouble is that these situations tend to get polarized much more easily than connections happen. So keep your ‘care relationship radar’ on at all times, and whenever complexity enters the picture, aim to simplify it. And there’s no better cure for complexity than communicating with an open mind.